Key treatment studies of lithium in manic-depressive illness: efficacy and side effects.

Lithium is the most extensively studied single psychopharmacologic agent. This review summarizes efficacy results of key studies in manic-depressive illness, the increasingly practical findings regarding predictors of response, and the implications of the increasingly better understood adverse effect profile of lithium. A recent well-designed study confirms earlier studies regarding the marked effectiveness of lithium in alleviation of acute mania. Early maintenance studies of marked superiority of lithium over placebo have been countered by recent open reports of lesser effectiveness. A recent randomized study provides support for the efficacy of lithium in maintenance therapy, but a satisfactory assessment of the effectiveness of lithium for maintenance and its optimal role requires further study. Many of the adverse effects of lithium can be addressed by dosage reduction, use of sustained-release lithium, or combination therapy.